Claim total
$767.69
base $93.83 · payer covered $617.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2002-05-31
- Stop
- 2002-05-31
The parties
- Patient
- patient Lavinia Kera Bartoletti
- Provider
- provider Magen Mertz
- Payer
- payer Medicaid
Record id
268d0250-7a61-15d4-e117-44df2c9ccb6d